Immigrants waiting for Green Card through family sponsorship to be hit hard by Trump’s new rule on health coverage

U.S. President Donald Trump speaks to reporters at the White House in Washington, U.S. January 23, 2018. REUTERS/Jonathan Ernst/Files

NEW YORK – In a move that will likely terminate applications of financially vulnerable immigrants from around the world who seek permanent residency through family sponsorship of a Green Card, President Donald Trump has signed a proclamation suspending entry of immigrants who will not be covered by health insurance within 30 days of entering the United States. The measure will take effect next month, from November 3, 2019.

The measure will commence less than three weeks after a new ‘Public Charge’ rule comes into effect on October 15. The latter has also the same underlying motive as the new proclamation: to deny permanent residency or Green Card to those immigrants deemed as being ‘unfit’ to secure a high enough paying job to sustain their self or family without the assistance of public assistance, like welfare, food stamps or Medicaid.

The measure on health coverage requirement is yet another in a slew of recent moves by the Trump administration, bypassing Capitol Hill and legislation in the House, to curb the flow of legal immigration, especially from Third World and developing countries.

Last month, the Trump administration announced it planned to allow only 18,000 refugees to resettle in the United States in the 2020 fiscal year, the lowest number in the history of the modern refugee program. Refugees are excluded from the new proclamation on health coverage, as well as those approved for asylum.

The new rule on health coverage, by far, though, will now pose the biggest challenge for immigrants and their family members with little or no professional skills, and who lack financial resources to buy their own health insurance.

Also hit hard would be ageing immigrants sponsored for a Green Card by their children. And for those with an existing medical condition, that Consular interview for a visa or Green Card could turn out to be a disaster.

For example, a family of four in India – waiting in line for perhaps a decade or more for a Green Card through the family sponsorship route, and eager to emigrate to the United States and start a new life – will now not only have to prove their worthiness to a Consular officer overseas that they have the skill and financial ability to not run afoul of the Public Charge rule, but also show the equivalent of maybe $15,000-$20,000 or more annually, just for their health insurance coverage in the unsubsidized market, unless a member or members of the family have secured employment in the US which provides health insurance or the family member who sponsored them has put all four under his/her plan too.

In essence, the Trump administration is sending as clear a signal as a red light at a traffic junction, to potential immigrants: don’t try to settle in the US if you are not wealthy enough or don’t have the skills to get a high paying job. Stay where you are, or go elsewhere.

The new rule on health coverage does not apply to those immigrants already on a visa or a Green Card. It also does not broach upon the issue of illegal immigrants who avail of health services, and are unable to pay for it.

“While our healthcare system grapples with the challenges caused by uncompensated care, the United States Government is making the problem worse by admitting thousands of aliens who have not demonstrated any ability to pay for their healthcare costs,” Trump said in the proclamation.

Headlined ‘Presidential Proclamation on the Suspension of Entry of Immigrants Who Will Financially Burden the United States Healthcare System’, the declaration issued on October 4th, noted the huge burden to the healthcare system who are not paid for services rendered, especially to immigrants.

“Hospitals and other providers often administer care to the uninsured without any hope of receiving reimbursement from them.  The costs associated with this care are passed on to the American people in the form of higher taxes, higher premiums, and higher fees for medical services.  In total, uncompensated care costs — the overall measure of unreimbursed services that hospitals give their patients — have exceeded $35 billion in each of the last 10 years,” it said, adding, “These costs amount to approximately $7 million on average for each hospital in the United States, and can drive hospitals into insolvency.  Beyond uncompensated care costs, the uninsured strain Federal and State government budgets through their reliance on publicly funded programs, which ultimately are financed by taxpayers.”

The proclamation said: “Beyond imposing higher costs on hospitals and other healthcare infrastructure, uninsured individuals often use emergency rooms to seek remedies for a variety of non-emergency conditions, causing overcrowding and delays for those who truly need emergency services.  This non-emergency usage places a large burden on taxpayers, who reimburse hospitals for a portion of their uncompensated emergency care costs.”

It added: “While our healthcare system grapples with the challenges caused by uncompensated care, the United States Government is making the problem worse by admitting thousands of aliens who have not demonstrated any ability to pay for their healthcare costs.  Notably, data show that lawful immigrants are about three times more likely than United States citizens to lack health insurance.  Immigrants who enter this country should not further saddle our healthcare system, and subsequently American taxpayers, with higher costs.”

The declaration said that United States has a long history of welcoming immigrants who come lawfully in search of brighter futures, that “we must continue that tradition while also addressing the challenges facing our healthcare system, including protecting both it and the American taxpayer from the burdens of uncompensated care.  Continuing to allow entry into the United States of certain immigrants who lack health insurance or the demonstrated ability to pay for their healthcare would be detrimental to these interests.”

In the proclamation, Trump said immigrants would have to show health care coverage through the following means: an employer-sponsored plan, including a retiree plan, association health plan, and coverage provided by the Consolidated Omnibus Budget Reconciliation Act of 1985; an unsubsidized health plan offered in the individual market within a State; a short-term limited duration health policy effective for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States; a catastrophic plan; a family member’s plan; a medical plan under chapter 55 of title 10, United States Code, including coverage under the TRICARE program; a visitor health insurance plan that provides adequate coverage for medical care for a minimum of 364 days — or until the beginning of planned, extended travel outside the United States; a medical plan under the Medicare program; or any other health plan that provides adequate coverage for medical care as determined by the Secretary of Health and Human Services or his designee.

Although the new rules does not apply to a child of a United States citizen or who is seeking to enter the United States through a visa, it does cover children accompanying a parent who is also immigrating to the United States. In essence this would pertain to those coming under a visa, including H-4 visa.

The proclamation warned that “an alien who circumvents the application of this proclamation through fraud, willful misrepresentation of a material fact, or illegal entry shall be a priority for removal by the Department of Homeland Security.”

It’s likely that the Trump administration may issue new rules in the future to monitor new immigrants who show personal finances or family-sponsored health coverage, at the time of a Consular interview.

Doug Rand, a former White House official in the Obama administration who worked on immigration policy, was quoted in The Washington Post as saying Trump’s proclamation is likely to affect the immediate relatives of US citizens waiting overseas for permission to come to the United States, including parents, spouses and siblings.

“As a matter of policymaking this is an incredibly flimsy document,” he said. “We have no idea what the process was and it just kind of happened at 7 o’clock on a Friday. Where did this come from? What was the process? Who was involved in this?”

Rand also told The New York Times in a separate interview that the latest proclamation also has logistical obstacles, noting that the State Department has a brief window to teach thousands of consular officers how to determine whether prospective immigrants can pay for their medical care.

“If this is not going to be enjoined by a court in the next month,” Rand said, “it will cause complete chaos.”

A Kaiser Family Foundation study said about one in four “lawfully present immigrants” lacked health insurance, compared with less than 1 in 10 U.S. citizens as of 2017, noted the Post.

A National Academies of Sciences report in 2016, however, concluded immigration had a positive impact on economic growth overall in the United States, though immigrants were more likely to compete with less educated Americans and other immigrants for jobs.

Thousands of people annually would be denied green cards if the executive order takes effect, said Steve Yale-Loehr, an immigration scholar at Cornell Law School.

“President Trump has failed to build a physical wall along the U.S.-Mexico border to deter illegal immigrants,” he was quoted saying in The New York Times, adding, “but he has effectively built an invisible wall to keep out legal immigrants.”




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